About this Research Topic
Transcatheter procedures for structural heart diseases carry a significant thromboembolic and concomitant bleeding risk, not only during the procedure but especially during the peri- and post-procedural period. These procedures include transcatheter aortic valve implantation (TAVI), left atrial appendage closure (LAA occluder), persistent foramen ovale (PFO), atrium septum defect (ASD) closure and transcatheter procedures related to mitral and tricuspid valve repair. Many issues concerning the optimal peri- and post-procedural antithrombotic therapy are still under debate and authority-based practices have been recently questioned.
Especially, the concern for antithrombotic therapy after TAVI is of increasing clinical relevance as recent data have shown that transcatheter heart valve thrombosis (subclinical and clinical) is more frequent than initially believed. Moreover, the importance for optimal antithrombotic therapy is underlined by the close association between subclinical transcatheter heart valve thrombosis and related adverse events.
In mitral and tricuspid valves, some achievements have been made over the past few years resulting in a fair amount of new transcatheter devices with different characteristics and implantation techniques. However, optimal anticoagulation in these patients is still under investigation.
Furthermore, antithrombotic treatment after cardiac device implantation, such as ASD/PFO and LAA occluder is a matter of debate and its duration and choice of antithrombotic agent differ between hospitals. In addition, issues related with anticoagulation of patients carrying left and/or right ventricular assist devices have not been fully covered so far.
Thromboembolic events are also associated with the presence of permanent pacing leads. In the majority of cases, they have been reported as a late problem but associated embolisms have been reported at any time. Especially venous thrombosis after permanent cardiac pacing is more common than assumed.
This Research Topic will address a subject around the optimal antiplatelet and anticoagulant treatment for transcatheter interventions related to structural heart disease and cardiac device implantation, which are at a rise in interventional cardiology. An understanding of the thromboembolic complications related to these devices is important because prompt diagnosis and therapy may diminish the potential for morbidity and mortality.
Overview articles, systematic reviews and meta-analyses as well as expert opinions should be submitted covering issues related to pre-, peri- and post-interventional antithrom-botic treatment in following indications: TAVI in aortic, mitral and tricuspid valve positions, transcatheter valves and devices in mitral and tricuspid positions, ASD/PFO/LAA occluder, RVAT/LVAT, transvenous cardiac pacing. Articles should cover the pathogenesis of device associated thrombosis, antithrombotic treatment for its prevention with a special focus on therapy choice (antiplatelet agent vs anticoagulation: vitamin K antagonist vs novel anticoagulants NOAC) and its duration. Additionally, articles should discuss diagnostic tools for device associated thrombosis and its therapy. Articles should summarise the evidence in tables, figures and, if the case of lacking recommendations, propose algorithms for prevention, diagnosis and treatment of device associated thrombosis.
Keywords: TAVI, TAVR, NOAC, aortic stenosis, mitral insufficiency
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